Sunday, May 8, 2011

Well, it's been a while, but Mom has another UTI. She's back to the delusions about being shot/hung/hunted and she is once again refusing to eat. They did a UA and the bacteria in the UTI is enterococcus faecium, which is a very resistant bacteria and different from the last one she had (although that one was VRE also).

We've been presented with some options, none of which are good. There is only one oral (pill) antibiotic that is effective on this bacteria, Zyvox(?)....anyhow....the problem with that one (aside from the fact that it is not covered by insurance and costs $100 PER PILL<--not a typo--at 2 pills per day for 14 days) is that my mom is on two antidepressants that can interact with the antibiotic and cause a very bad side effect, "seratonin syndrome". Even if they take her off the antidepressants for 3-4 weeks prior to starting the antibiotic, there is still a chance that the interaction could occur.

Or....there are 4 or 5 antibiotics that could be given intravenously that would probably be effective. The problem with that is that the NH has several times now informed me that they WILL NOT administer IV antibiotics at the NH, so Mom would have to go to the hospital, which could make any improvement caused by the antibiotics a moot point, because she always gets so confused in the hospital...and even if some of the "hospital confusion" cleared up when she made it back to the nursing home, some of the confusion ALWAYS remains as yet another cognitive step down...the nursing home has also expressed doubt about whether my mom would pull out the IV or not, because she wouldn't remember/understand what it is. Yesterday, I talked to the nurse practitioner (a new one who has only been working there a month) and she said that if I insisted, they could do the IV antibiotics at the nursing home, but....so I'm clear on the fact that the nursing home does not want want to do the IV, but not clear on whether I could actually force the issue or not. And with any antibiotic use comes the possibility of C. Diff., which is a very bad infection where the antibiotic(s) basically kill all of the "good" bacteria in the gut and cause life-threatening diarrhea.... also...not to mention that if we did the IV antibiotics, she might get another UTI next week again and we'd be in the exact same place, except potentially broker and wiser....at this point, since it has really not appeared to be an option, I'm not sure if Mom's insurance would cover the IV/antibiotics or whether it would be out of pocket.

Or...we could do "nothing" and just try to support her and see if she can fight it off for a while....I asked the NP (who I do not like) what kind of prognosis we would have if we chose this option and she said "well, if/when it moves into her kidneys....about 2 weeks..."

I need information. But I don't even know who to ask....

Also, though, I have to add, that the RN's and LPN's at the nursing home--they have been so amazing--I cannot believe the support and understanding I've been getting during this--two nurses even went to the director of nursing to plead for the chance to do the IV at the nursing home (and were told no)....they are very upset that there doesn't appear to be anything "doable" and one of the nurses teared up when she told me how upset she'd be if it was her mom in this situation....If my mom has to be in a NH, and even though the higher ups aren't on my list of favorite people, the folks on the front lines (the aides and nurses) could not possibly be more compassionate and caring....

I called my brother to get his thoughts and he said "I guess I need to get working on...." and I thought for sure he was going to say "coming up to visit more often".....but you know what he said?  "all the funeral arrangements..."!--guess I won't be getting a lot of support from him....but I was hoping....

I honestly don't know what to do.  If anything.  I strongly suspect that this will be the last Mother's Day that I share with my mom.